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Background: Butaro Cancer Center of Excellence (BCCOE) was founded to serve Rwanda's rural low-income population, providing subsidized cancer diagnosis and treatment with transport stipends for the lowest-income patients. We examined whether travel distance to BCCOE was associated with advanced-stage diagnoses and treatment completion. Methods: We conducted a retrospective cohort study using medical record data from BCCOE patients with pathologically-confirmed breast cancer from 2012–2016. Women with no prior surgery were included in the stage analysis; those with non-metastatic disease were included in the treatment analysis. We calculated travel distances using spatial analytic software and used multivariable logistic regression to examine the association of distance and other patient characteristics with late-stage diagnoses and treatment completion within one year of diagnosis. Results: The analytic cohort for stage included 426 patients; 75.1% had late-stage (stage 3 or 4) disease. In univariable analyses, patients residing in BCCOE's surrounding district had a lower proportion of late-stage diagnoses compared to those residing outside the district (57.9% v 76.8%, p = 0.02). In adjusted analyses, odds of late-stage diagnosis were 2.46 (95% CI:1.21–5.12) times higher among those in distance quartile 4 (> 135.8 km) versus 1 (< 55.7 km); the effect of distance was less strong in sensitivity analyses excluding patients from BCCOE's surrounding district. Patients from sectors with > 50% poverty had 2.33 times higher odds of late-stage diagnoses (95% CI:1.07–5.26) relative to those with poverty < 30%. In the treatment completion cohort (n = 348), 49.1% of patients completed surgery and chemotherapy within a year. In adjusted analyses, travel distance and poverty were not linearly associated with treatment completion. Conclusions: At Rwanda's first public cancer facility, sector-level poverty and longer travel distances were associated with late-stage breast cancer diagnoses, but less clearly associated with treatment completion, perhaps partly due to travel stipends provided to the lowest-income individuals undergoing treatment. Our findings support further investigation into wider use of travel stipends to facilitate early diagnosis and treatment completion. [ABSTRACT FROM AUTHOR]

Most construction projects encounter safety issues that may affect project effectiveness and the lives of workers. Although various studies have investigated these factors, in some countries, such as Rwanda, there is still little empirical evidence regarding the important aspects that contribute to safety effectiveness. Therefore, this study was carried out to predict the resilient safety effectiveness in the Rwandan building construction sector via the artificial neural network (ANN) model. Through a literature review, resilient safety variables that may be relevant in the Rwandan construction sector were identified. Data were collected through questionnaires. Moreover, the levels of importance of resilient-safety-effectiveness-related factors were pinpointed and assessed using the analytical hierarchy process (AHP). Consecutively, an ANN model that could predict the effectiveness of resilient safety was developed. This study contributes to the awareness of key factors that may affect the effectiveness of resilient safety, and it helps to forecast the effectiveness of resilient safety not only in Rwanda, but also in other low- and middle-income countries with different conditions by stressing the importance of reducing safety-related risks in building construction projects. [ABSTRACT FROM AUTHOR]

Background: Strong partnerships, community engagement, and multisectoral collaboration in the health supply chain are synergistic pillars towards achieving universal health coverage. In Rwanda, the health supply chain involves the collaboration of various stakeholders, including distributors, manufacturers, wholesalers, and customers. However, since the eruption and ending of COVID-19, there has not been any study to assess stakeholders' perspectives on the status of the benefits, challenges, and best practices of collaborative partnerships among health supply chain stakeholders in Rwanda. Therefore, this research was conducted to fill that gap in order to devise ways for improved visibility, coordination, and efficiency of the health supply chain management system in Rwanda. Methods: This quantitative cross-sectional study, collected data from 11th April to 18th May 2024. It involved 103 respondents from 54 institutions engaged in the management of the health commodities supply chain in Rwanda. These were the Ministry of Health, Rwanda Biomedical Center, Rwanda Food and Drugs Authority, Rwanda Medical Supply Ltd, other Central Medical Stores namely Bureau des Formations Médicales Agréées du Rwanda (BUFMAR) and Medical and Allied Service Solutions (MEDIASOL); private wholesale pharmacies, non-government organizations, and Health Facilities (hospitals). A sample size of 103 respondents was determined by the Yamane formula, and purposive sampling was used to select the respondents to complete a self-administered questionnaire specifically developed for this study. The outcome measures were perceived benefits, challenges, and strategies to overcome challenges of collaborative partnerships among health supply chain stakeholders in Rwanda. Results: Availability of health commodities ranked at 98.0%, infrastructure/accessibility of health services (86.4%), and cost-effectiveness (84.5%) were the most mentioned benefits. Most stated challenges included insufficient financial resources from stakeholders (84.5%), shortage of skilled staff (77.7%), and limited dialogue or lack of information sharing (69.9%). Most respondents agreed that collaborative partnerships can be improved by political will (96.1%), supply performance measurement (92.2%), improved financing policies (84.5%), fostering trust and transparency building (78.6%), and a well-structured health supply chain (72.5%). Conclusion: Establishing and strengthening stakeholder collaborations are essential for improved performance. Staff capacity strengthening and mutual information sharing will reduce risks, and improve forecasting, leading to cost-effectiveness and customer satisfaction. [ABSTRACT FROM AUTHOR]

Dietary diversity has been widely used as a proxy indicator for micronutrient adequacy. In low‐ and middle‐income countries (LMICs), including Rwanda, women are at high risk of inadequate micronutrient intake resulting from poorly diversified diets. This study was conducted to examine the factors associated with women's dietary diversity, with emphasis on homestead production diversity and market access in the Northern Province of Rwanda. A cross‐sectional design was used, involving 606 women aged 18–49 years. Linear regression analyses were performed to examine the association between various factors and women's dietary diversity. Results show that 84% of the sample households raised at least one livestock species. Seventy‐one percent of the households had no agricultural land. Eighty percent of those without land had a homestead garden on which they grew food crops, mainly vegetables and fruit trees. The average crop species was 2.3. On average, women consumed 3 out of 9 food groups. The homestead production diversity score was positively associated with women's dietary diversity score (β = 0.16, p < 0.001). Women's dietary diversity score was negatively associated with distance from the household to the nearest market (β = −0.08, p = 0.027) and household food insecurity (β = −0.06, p < 0.001). Maternal education (p < 0.001), household wealth index (p < 0.05), and ownership of more than 2.5 acres compared to being without land (p < 0.05) were associated with women's dietary diversity score. The dietary diversity of women could be enhanced through interventions that promote the diversity of livestock and crop species produced through homestead production. Potential interventions to explore may include integrated farming systems that combine small livestock and crop production utilising improved livestock breeds and high‐quality seeds and planting materials of high‐yielding varieties of fruits and vegetables, along with rainwater harvesting to facilitate small‐scale irrigation. The impact of such interventions on women's dietary diversity can be further reinforced by parallel programmes aimed at improving women's education and the socioeconomic status of households. Key messages: Homestead food production, maternal education, access to land, and household wealth index are positively associated with women's dietary diversity score in the Northern Province of Rwanda.Women's dietary diversity score decreases as the distance from the household to the nearest market increases and with higher levels of food insecurity.Interventions to promote the diversity of livestock and crop species produced through homestead production can potentially contribute to improving women's access to and consumption of diverse foods. Their impact can be strengthened by complementary programmes that improve women's education, market access, and households' purchasing power. [ABSTRACT FROM AUTHOR]

Introduction: Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator., Methods: We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS)., Results: Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty., Conclusions: This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In Rwanda, many abortion services are not currently providing trauma-informed abortion care (TIAC) due to laws that restrict service provision and the incorporation of potentially traumatizing procedures with little attention to the woman's experience and support needs. Midwives working in abortion services often lack adequate training to effectively support clients with trauma. The authors aim to evaluate midwives' knowledge, attitudes, practices, and experiences toward TIAC. A mixed-method design was used. In quantitative, all midwives were invited to participate. In qualitative, purposive sampling was applied, and four focus group discussions with eight participants each were conducted. Of the 167 midwives who participated in this study, 86.2% demonstrated sufficient knowledge of TIAC, 83.8% had thorough experience of TIAC, and 62.3% reported a negative attitude toward TIAC. Respondents with an advanced diploma were more likely to have satisfactory knowledge than those with a bachelor's degree, and the workplace institution influenced TIAC practice. Males had a more positive attitude compared to their female counterparts. Moreover, respondents with more knowledge of and positive attitudes toward TIAC were significantly more likely to have good practice. Four themes were identified: a) conceptualization and practice of TIAC; b) TIAC as an essential practice in quality care; c) physical environment as a hindrance of TIAC; and d) dynamics of caring leading to secondary trauma. Providing TIAC training to midwives is essential for shifting negative attitudes. Hospitals need to enhance their infrastructure and offer resources to address the challenges of abortion services, including mitigating secondary trauma among healthcare workers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)